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: ^ ill RICE SIXPENCE. 

;S: ! 
[■l 




WHAT IT IS, 



HOW TO PREVENT IT. 



EDWIN LANKESTER, 

M.1X, F.R.S. 

. lb . 

' 8 

&£> LONDON! 

UfcUK^fi ROUTLEDGE & SONS, 

THE BROADWAY, LUDGATE. 



/ 



\ 



1 



J * 



; 



CHOLERA: 



WHAT IS IT! 



AND 



HOW TO PEEVENT IT. 



• • 
• •• 



• • • 



• • 



• • 



• • 



• • • 2 •• 

• • • • • • • 

• •• • • • * 









BY 



EDWIN LANKESTER, M.D., F.R.S. 

MBXBBB 0» THE BOTAL COLLEGE 0» FHY8ICIA2T8, LOWDOWJ IdDIOAX 
OF JICEB O* HEALTH 0* ST. JAHES'S, WSSTHUTflSB. 




GEORGE ROUTLEDGE AND SONS, 

BROADWAY, LT7DGATB. 
NEW YOEK: 416, BROOMS STREET. 



• * 



• • 



• • • 



• * 



• • 



£oBDb&? 

BATXLL AJTD IDWUtDS, PEI1CTBE3, CHAJTD08 BTEXET, 
COTSHT OABDB1T. 



Lea 



CONTENTS. 



CHAPTER L 

FAGl 

HISTORY OF CHOLERA 7 



CHAPTER II. 

IS CHOLERA CONTAGIOUS? . . • .13 

CHAPTER III. 

SYMPTOMS OF CHOLERA 20 

CHAPTER IV. 

THE POISON OF CHOLERA • . . .24 

CHAPTER V. 

THE CAUSES OF THE TENDENCY TO TAKE 

CHOLERA ^ 

A» 



IV CONTENTS. 

CHAPTER VL 

PAG* 

HOW CHOLERA. POISON IS CONVEYED . • 57 

CHAPTER VII. 

HOW TO PREVENT CHOLERA ... 63 

CHAPTER VIII. 

WHAT TO DO WHEN CHOLERA BREAKS OUT . 79 

CHAPTER IX. 

ON DISINFECTANTS 83 



Appendix • 90 



NOTICE. 



The following remarks were written at the re- 
quest of the publishers, and were undertaken by 
the author, in the hope, that they may serve in 
some measure to instruct those who may read 
them, in the causes and means of preventing 
the terrible disease with which the country is at 
present threatened. 

23, Great Marlborough Street. 
August 22, 1866. 




There are few epidemic diseases which have 
excited more alarm and givon rise to greater 
apprehensions than the disease known popularly 
as Cholera. Although this name, for a certain 
form of disease, has been familiarly known to 
medical men from the time of the Greek and 
Roman writers on medicine, it has only heen 
within the last fifty years that it has gained a 
special significance, and has heen associated with 
the word Asiatic, to indicate more especially its 
origin on the continent of Asia. Previous to 
its outhreak in Hindostan, in 1817, the disease 
known by the name of cholera had never been 
seen as an epidemic disease in Europe, and 
certainly had never heen regarded as contagious. 
In the autumn of the year in most countries of 
Europe, and also in Great Britain, the disease 
called cholera was familiar, and medical writers 
called it Cholera Morbus. This disease was 
attended with the symptoms ol ^at^jsnj, w 1 ^ 



! 



HISTORY OF CHOLERA. 



on of 



vomiting, and seemed to be an exaggeration of 
the state of system in which diarrhoea usually 
i. It was frequently fatal, and morB 
prevalent in some places than in others. 

It was between the years [817 and 1830 that 
aocounis were brought from our possessions in 
the East Indies that created alarm, lest the 
disease, which had devastated Hiudostan, should 
by any means be conveyed to this country. The 
history of its outbreaks and the facts of its 
propagation showed that it might he conveyed 
in any direction along the lines of human inter- 

The first accounts we heard of the disease 
were from places situated on the delta of the 
Ganges, where it appeared at the end of May or 
the beginning of June, 1817. From this spot, 
in the years 1818-19, it extended itself through 
the whole of the Indian peninsula. In 1820 it 
found its way to China, and in the following 
year ravaged the populsus islands of the Indian 
Archipelago. In the same year it .appeared 
on the shores of the Persian Gulf, spreading 
to parts of Arabia, Syria, and Persia, thus 
threatening Europe. In 1823 it was first seen 
in Russian territory, in Tiflis, Orenberg, and 
AstracRB. Here the disease seemed for a time 
» have been arrested, hut it again VtoYs <M> 






in Oreubcrg in 1828, and in 1830 advanced to 
the southern frontiers of the Russian empire, in 
which year Moscow was attacked. In March, 
1831, the disease was at Warsaw, in May it ap- 
peared at Dautzig, and in Sunderland in October 
of the same year. In the following year it 
broke out in Paris and in London. In all thi 
places the disease appeared suddenly, and spn 
with irresistible force, speedily attaininj 
maximum of mortality, and then us sudderil 
retiring. After this first outbreak of the disei 
in Europe it again disappeared, but another out 
break was again reported in India, which, tra- 
velling in almost the same route, appeared in 
Europe in the years 1847-48, and 49. Again 
London and many of the great towns of Eng- 
land were attacked, and again became free from 
the disease. A third visitation occurred in 
the years 1852-3-4. London was visited in 
the latter year, and although the mortality was 
not so large as in the previous attacks, the 
disease appeared to have lost none of its viru- 
lence, and the number which died, in proportion 
to those attacked, was about the same. 

In.I8G-i this disease was again announced as 
invading Europe, and, in this instance, the line 
of its advance was somewhat different. We 
were first alarmed by the ys.^to w ^ q ' ^ '^wSws"*" 



iber 

i 



>' 



10 HISTORY OF CHOLERA. 

for the fourth time, by reports of its appearance 
in Egypt, more especially along the march of 
the army of pilgrims from Mecca. The disease 
was clearly not generated at Mecca, but brought 
there by Mohammedan pilgrims from the East.* 
From Mecca it was brought by the returning 
pilgrims to Alexandria, and thence along the 
ports of the Mediterranean to Southern Europe. 
The localities of tho first attacks in England 
were' somewhat different. In previous attacks 
it had first appeared in the north. This time 
we heard of it first in the south. It first 
appeared at Southampton on the 10th of 
July, and subsequently was reported at Wey- 
mouth, Portland, and Dorchester. One of the 
most singular episodes in the history of the 
arrival of cholera in England in 1805, was its 
appearance in a small village named Theyden- 
Eois, near Epping. Here lived a farmer who, 
with his wife, went to spend a fortnight at 
Weymouth in September last. On returning 
home he was seized with diarrhoea. Ho, how- 
ever, arrived at home on the 26th of September. 
His wife, after getting home, was attacked with 
tho same complaint, and died on the 11th of 
October, with all the symptoms of cholera. 
By Tilbary Fox, MD. 



HISTORY OF CHOLERA. 11' 

Subsequently the farmer himself died, and of 
eleven members of his family attached, eight died- 
It was found in this case, that all the drinking 
water of the household came from a well iuto 
which tbe soahings of the water-closet con- 
tinually flowed. The conclusion arrived at in 
this case was that the farmer bad contracted the 
disease in the south of England, and poisoned 
the well from which his family partook their 
drinking water. A curious point iu connexion 
with this case has been pointed out, and that 
is, that the sewage of this house flowed into 
tbe river Coffin, a little stream which empties 
into the river Lea* 

As to how the outbreak occurred at South- 
ampton there can he little doubt, as several 
vessels had arrived there from the Mediterra- 
nean with cholera on hoard. In the same man- 
ner cholera appeared on board emigrant ships 
coming from Holland with German emigrants 
on board. Cholera having prevailed extensively 
in Rotterdam and other cities on the Continent 
during the summer of I8G5, explains the cause 
of the outbreak in these ships. 

These, then, were the principal indications 
that we had iu 18(i5 that we might apprehend 

* " Eighth llcport of the Medical Officer of thu Pclv^ 
Council, with Appendix." IftEiQ. 



HISTORY OF CHOLERA. 



an outbreak of cholera in London, Soutbamptoi 
or Liverpool in 1806. In June of this year 
•was announced that cholera cases had occurri 
again in Southampton nnd Liverpool, whilst a 
larger amount of diarrhoea than usual occurred 
in London. It waa not, however, till the 2nd 
of July that the mortality assumed a serious 
aspect; it was then found from the weekly 
return of the Registrar- General that the deaths 
which were 1292 on tho 7th of July were 1B4I 
on the 14th, 1798 on the 21st, and 2600 on tl 
28th of July. 

The mortality of London was doubled by this 
explosion of cholera, and the greatest anxiety 
prevailed lest the disease which bad so suddenly 
broke out should extend in all directions. It 
was soon, however, found that the attack waa 
confined to the east end of London. It was 
further observed that the cases principally 
occurred in those districts of London compris- 
ing Wbitechapel, Bethnal Green, Bow, and 
Poplar, supplied with water by the river Lea. 
It was also found that this district waa the only 
one in London to which the great main drainage 
works now being completed bad not extended, 
On these grounds a hope was expressed that 
the disease might not extend to other parts of 
-London, But should this hope lead to care- 



, a 



.hs 
40 

» 



HISTORY OF CHOLERA 13 

lessness on the part of individuals, and neglect 
on the part of public authorities, a single case 
imported from the infected district may be the 
means of a similar explosion in any other part of 
London. It is with the object of preparing the 
public to understand the nature of this terrible 
pestilence, and to put them in a position to 
resist its influence, and prevent its spread, that 
these pages are written. It is not by keep- 
ing the public in ignorance of the nature of 
this disease that any good can be done ; but 
it is by imparting an intelligent apprehension 
of the great natural laws involved in the course 
and progress of this disease that we may hope 
to deprive it of its fatality, and even convert its 
awful presence into a future blessing. 



CHAPTER II. 

IS CHOLERA CONTAGIOUS ? 

After the previous history, it would appear to 
some people almost superfluous to ask this 
question. A disease which is traced from a 
central locality, whioh has constantly been 
carried from that spot by human intercourse, 
that is never known to spring up spontaneously, 
but always to travel through the agency of in- 
fected persons, bears all the character of a con- 
tagious disease, and the facts will hardly bear 
interpretation in any other way. Nevertheless, 
great donbt3 have been thrown upon the theory 
of its contagiousness. Many of the govern- 
ments of Europe have treated it at times as 
non-contagious, and none more obviously than 
our own, and there are many distinguished 
medical men even at the present time who 
. maintain that the disease is not contagions 
Unlooked for as it might be, there is evidence 
to show that the maintenance of these oppo- 
site opinions about the contagiousness of cer- 
tain diseases is not altogether unconnected 



18 CHOLEKA CONTAGIOUS ? 1. 



with political views. Thus during the early 
part of this century the free-trade party i 
most earnest in their efforts to induce the 
governments of Europe to abandon the quaran- 
tine of vessels proceeding from infected ports. 
In order to gain this end they endeavoured to 
show that the plague and other diseases for 
which quarantine had been established were not 
contagious. This party foresaw that the arrival 
of cholera would be the signal for securing 
obstructive quarantine regulations, and some of 
their leading men were distinguished for their 
maintenance of the theory of the non-conta- 
giousness of cholera. Our government has 
always more or less leaned to this theory, and 
the most distinguished members of its sanitary 
boards have heen non-oontagionists. It ought, 
however, to be known that several of the scien- 
tific and medical gentlemen employed by the 
government have from time to time given in 
their adherence to the theory of contagion, and 
the recent reports of government agents confirm 
this theory, and the late regulations issued by 
the Privy Council* recognise to its fullest 
possible extent the theory that cholera owes 
its origin and extension to a poison secreted in 
the mucous membrane of the alimentary canal. 

* " Orders of Privy Council m. ietoi3s& Va CuJjctv" 
1866. 



■ 



1G IS CHOLERA CONTAGIOUS? 



If cholera ia not produced by contagion, the 
question comes as to what are its originating 
causes. Now, we are not without evidence to 
show that certain diseases arise and spread quite 
independent of any poison propagated within the 
human body. Thus we are familiar with a dis- 
ease in England known by the name of " ague," 
which evidently originates in a poison which is 
generated outside the human body. This poison, 
which without having been examined or even 
seen, we call malaria, is generated by decom- 
posing vegetable matter. We know the districts 
where it prevails — we know where it will pre- 
vail most, and we can at will remove the cause. 
In the same way the simple diarrhcea of this 
country occurs at a certain season of the year, 
it arises from definite causes; and here there is 
no specific poison or contagion passing from one 
body to another, and maintaining and spreading 
the disease. Reasoning from analogy there is no 
doubt that those who advocate the non-conta- 
giousness of cholera should point to our summer 
diarrhcea as the type of the more fatal disease, 
and that cholera is only, as it were, an intensi- 
fication of diarrhcea by certain meteorological 
conditions acting upon systems made susceptible 
by the unsauitary circumstances in which they 
have lived. Now these- two points have been 
most carefully examined. During tiie e^Aaiavis 



he 



13 CHOLERA CONTAGIOUS 7 17 

of 1848 and 1854 careful observations were made 
in London of the state of the atmosphere ; but 
although every condition was investigated with 
great laboriousness, no special conditions could 
be discovered which were connected with out- 
breaks of cholera. The disease has sometimes 
prevailed in mid-winter, whilst undoubtedly its 
attacks are more frequent in hot summer; but 
heat cannot be regarded as a cause. Humid 
atmospheres and climates seem to favour its 
attacks J but the cause of cholera has never 
been traced in any districts to humidity, 
is the same with other conditions of the air, its 
electricity, the presence of ozone, its density and 
elasticity have been all carefully examined, but 
no one of them, by their constant presence or 
absence, could for a moment be regarded as the 
cause of cholera. So recently as the outbreak of 
the cholera at Southampton in 1 865, the attack was 
investigated in reference to the meteorological 
conditions in that town ; and this was done with 
the ample resources of the Meteorological Ap- 
paratus of the Ordnance Survey Office in that 
town,* Careful observations made during the 
months of August and September showed that 
during the first month there was no unusual me- 

» See Dr. Parkes' Report in "Eighth Report of tlw 
Medical Officer of Privy Council." 



I 



18 IS CHOLERA CONTAGIOUS? 

teorological condition except an excess of rain, 
and in the last month an excess of heat and no 
rain. The experience in otber parts of the world 
has been the same : there is no condition of 
atmosphere ami season that can be laid hold of 
as the cause of cholera. There is one other 
point connected with the state of the air which 
was investigated at Southampton, and that is, 
the question of the possibility of the cholera 
miasm having been brought from a distance by 
prevailing winds. It was found that both before 
and during the pre valence of cholera the wind 
was blowing in all directions, and there was not 
the slightest evidence to show that any foreign 
or poisonous matter had been conveyed to the 
town by that agency. 

The second point on which the non-conta« 
gionista fay great stress is the occurrence of 
choleraindistricts where unfavourable local condi- 
tions exist. There is no doubt that cholera is most 
virulent and fatal in those towns and districts 
of towns where dirt and filth, and poverty and 
neglect of sanitary laws prevail. But we have 
yet to receive the facts on which the theory can 
be established that cholera is produced by any 
combination of organic and inorganic matters 
independent of a special poison. There ia 
nothiag more striking in the liiatovif of cholera 
outbreaks than to find it passing onei\ioAiae&,&*&- 



IB CHOLERA CONTAGIOUS? 19 

tricts, and towns remarkable for their deficient 
sanitary arrangements and general insalubrity - ) 
and fixing itself in localities where sanitary 
agencies have been comparatively active. Upon 
the -dirt and filth theory, how could we account 
for the outbreak at Southampton ? It was not 
in the dirtiest parts of Southampton and its 
neighbourhood that it occurred at all, hut here 
and there in isolated spots ; and to nearly all 
these spots the cholera was traced from on board 
the ships which had arrived from the Mediter- 
ranean with cholera on board. 

It has been by the entire failure of any other 
theory to account for the spread of cholera that 
inquirers have been driven to accept the theory 
that the disease is contagious, and that it is only 
propagated by a poison which being generated 
in one body 19 communicated to another. If 
there were only a probability of this being the 
true state of things, it is oT the utmost im- 
portance in all attempts to prevent the spread 
of the disease that this should he recognised, 
and that our efforts should be directed to the 
covering of both issues. All who have anything 
to do with cholera should act as though it were 
the most contagious of diseases, aud not neglect 
the removal of dirt and filth, as though they 
were the real producers o£ t\ia cBAWttoA."i» 



I 




CHAPTER HI. 

SYMPTOMS OF CHOLERA. 

The duration of nn attack of cbolera v 
two or three hours to several days. Medical 
men recognise three stages: — 1. A premonitory 
stage. 2. The stage of collapse. 3. The febrile 
or reactionary stage. 

The premonitory stage is tliat in which the 
symptoms are those of ordinary diarrhrea. There 
is looseness of the howels, with or without 
pain. In this stage cholera is not to be distin- 
guished from ordinary diarrhoea. It is, however, 
of the utmost importance when cholera is prevail- 
ing that no case of diarrhcea should be treated 
as merely an ordinary case of that disease, aa 
all experience shows that where this premonitory 
diarrluea is early attacked it may be arrested and 
the- more formidable symptoms of cholera pre- 
vented. At the same time there are, no doubt, 
cases m which these preliminary symptoms 
suddenly pass into the subsequent stages, kq&. 



SYMPTOMS OF CHOLERA. 'i\ 



forbid anything like treatment that would lead 
to the arrest of the disease. 

The second or cold stage of collapse is cha- 
racterized by both purging and vomiting. The 
stools cousist of a watery, colourless fluid, with- 
out smell, and having the appearance of barley 
or rice water. In this fluid are observed flakes 
of an nlbiiminous character floating about. 
Whilst these discharges are very frequent, the 
patient complains of severe cramps, especially 
in the legs. These symptoms are accompanied 
with great exhaustion, giddiness, and general 
weakness. The pulse becomes small, frequent, 
and accelerated, and as the disease advances, 
almost imperceptible. The skin becomes cold 
and is covered with a profuse sweat or a 
clammy moisture. The temperature of the 
whole body is perceptibly lower. A thermometer 
placed under the tongue will indicate a tempe- 
rature much below the natural heat of the body. 
There is great restlessness ; the patient, though 
so cold, complains of heat and throws off the 
bedclothes. There is great thirst and pain at 
the pit of the stomach, and the respirations are 
much more frequent than usual. The features 
are shrunk and anxious, the eyes are dull and 
suffused, the tongue is moist but cold, the wto 
is feeble, hollow, and hoarse, wai. ^erj «3mss 






22 SYMPTOMS OF CHOLERA. 



teristic of the disease. As the disease advances 
the skin is not only cold but blue. Hence tha 
names Algide Cholera and Blue Cholera which 
have been applied to this disease. The functions 
of the brain remain unimpaired to the last. As 
the disease advances the urine becomes sup- 
pressed, the pulse becomes smaller, and the 
patient dies of exhaustion. Death sometimes 
comes on very rapidly in this stage without all 
the symptoms being doveloped. In other cases 
all these symptoms continue for many hours or 
even days, and eventually the third stage, that 
of consecutive or reactionary fever sets in, 

In this stage the coldness and blueness of the 
skin gradually disappear, the pulse acquires in- 
creasing force, the face becomes flushed, the 
vomiting is less frequent, the diarrbcea continues. 
The urine is secreted again, and other favourable 
symptoms are observed. Although this stage is 
indicative of an ability on the part of the patient 
to resist the disease, lie not unfrequently suc- 
cumbs, and dies from exhaustion some days, or 
even weeks, after his first attack. 

As the object of these pages is not the in- 
struction of the medical student, we shall not 
pursue the question of the symptoms of thi3 
disease any further, nor shall we enter into the 
question of the causes of the symptoms ^«\i\c\\ 



ices 



SYMPTOMS OF CHOLERA. 23 

are presented in its course. Melancholy as is the 
duty of watching hy the bedside of the suffering, 
and painful as the attendance upon the sick who 
cannot be rescued from their fate maybe, there 
is after all a profound interest awakened in the 
inquiring mind as to the nature of that poison 
which invisibly introduced into the system of 
the living man so soon acts upou every organ, 
and in so many instances destroys the fabric of 
the most perfect organism in the course of a 
few hours. The havoc of the tornado in i 
tropical forest gives but a faint imago of the 
effects of this poison when once it has gained 
access to the wonderful mechanism of the liumai 
frame. 

The intense* interest excited in the mind of 
the scientific inquirer, is the guarantee that as 
long as this disease shall be a scourge to man- 
kind, so long will there be intense minute and 
anxious research into the nature of that chain of 
causes which results in the wonderful and disas- 
trous effects of this disease upon the human body. 



CHAl'TEH IV. 

THE POISON OF CHOLERA. 

All contagious diseases are the result of three 
great factors, tho absence of any one of which 
must prevent an epidemic. 

There must he first a special poison ; second, 
a person -predisposed to take that poison; and 
third, a medium conveying the poison to the 
predisposed individual. In other words there 
must he a poison-maker, a poison-taker, and a 
poison-bearer. Unless these three things nre 
present there will be no spread of contagious 
disease, and I may illustrate this position by 
what takes place in a disease which is uni- 
versally admitted to be contagious, I mean small- 
pox. In order to propagate this disease there 
must be, first, the poison-matter from n small- 
pox pustule; secondly, a person predisposed 
to take the disease ; and thirdly, a medium 
for the conveyance of the poison, either the 
point of a lancet inserted into tho flesh, or an 
atmosphere to convey the poisonous getm. \l 



THE POI30S OF CHOLER. 

the poison is not there no amount of prodi: 
position will serve to engender the di 
Again, if tho poison be there and the predi 
posed person — nnleBS some medium is presenl 
unless the poison is conveyed to the predisposed 
person, there will he no produotion of the di: 
A person predisposed to take the small-pox 
may stand by the bedside of one who has the 
disease, but if the current of air blows awa; 
from the predisposed person, the poison will n< 
come near him, and he will escape ; or the atmo> 
sphere in which both are placed may be so ex- 
tensive, that the poison being diluted will not act 
upon the predisposed individual. But let the 
poison be ever so intense, and tho medium ever 
so ready to convey it, if tho unaffected individual 
has been vaccinated, he is not predisposed 
take small-pox, aud he will not contract tho dh 
ease. There is no problem in our social life 
which people ought to study with greater dili- 
gence than this. It is the key to the suppres- 
sion of contagious diseases, and the delivery 
mankind from at least half the causes of thei 
disease and death. Let us, then, study cholei 
from these three points, and first ascertain win 
we know about the poison of cholera. 

At first sight it might a^oeat feA. -^^ cw&S 
know nothing about tiie \a."«B viWa. tw&N&s^a^ 



3X 

he 

: 

et 

be 
■iter 
lunl 
I to 
dis- 
life 

rea- 
,of 
heir 
lera 



26 THE FOISON OF CIIOI.ETU. 



nature of a poison whose presence we had never 
been able to detect, and whose very existence 
has been denied. But when we oall to mind the 
fact that the poisons of ague, of scarlet fever, of 
diphtheria, of measles, and of hooping-cotigh, 
have never yet been separated and observed, and 
that few are bold enough to deny their existence, 
we shall see that the poison of cholera may be 
regarded as a special existence, as much as any 
of these poisons. In the case of small-pox 
above alluded to, we have been able to separate 
the poison. We know that it consists of par- 
ticles of matter which have been generated in 
pustules in the skin, and reasoning by analogy, 
we are led to believe that the germs which pro- 
duce scarlet fever and measles, are likewise pro- 
duced upon the skin. There is a close resent 
hlance between the structure of the skin and the 
mucous membranes of the alimentary canal. 
Now, cholera is eminently an affection of the 
roncous membranes of the stomach and howels, 
and we have thus reason to believe that just as 
poison germs or cells are thrown off the struc- 
ture of the skin in small-pox and scarlet fever, 
so poisonous cells or germs arc thrown off from 
the mucous membranes of the howels during an 
attack of cholera. The difference between the 
ordinary discharges of the bowels m\1 Voose 



I 






THE POISON OF CHOLERA. 



which take place in cholera, 19 as great as the 
difference between ordinary perspiration and the 
exhalations which pass off from the skin in 
scarlet fever. One is perfectly harmless, the 
other produces n specific disease. 

Cholera is not the only disease which affects 
the lining membrane of the stomach and bowels, 
and whose action is to produce a poison on the 
mucous membrane. There is a disease very com- 
mon in this country, known as gastric or typhoid 
fever,the disease to which the late Prince Consort 
fell a victim, which consists in an affection of 
the mucous membrane of the bowels, and which 
renders the discharges from the barrels highly 
contagious. This disease in the mode of its 
propagation, and the nature of its poison, greatly 
resembles cholera, but the action of its poison 
is not so sudden or fatal as that of cholera ; and 
being a native of our own soil, and constantly 
amongst us, we give it much less attention than 
we do to the stranger from the East, who 
stalks in upon us occasionally and alarms us so 
much, although in the last twenty-five years it 
has done us infinitely more harm. We shall 
have reason after all to thank the stranger, if he 
teaches us how to destroy his brother, who ia 
native to our shores- 
All the evidence on •fllawV^e tcV* tot igtw-as^ 



Eh* 



88 THE POISON OF CHOLERA. 

that cholera is a contagious disease, points to 
the evacuations of the patient as containing 
the poieou germs. How these poison germs 
are distributed may be more easily conceived 
than described. But in a large Dumber of iso- 
lated cases of the occurrence of this disease, un- 
mistakeable indications of contact with the poison 
germs from the evacuations are given. Thesa 
germs, although more easily communicated 
through the agency of water, can undoubtedly 
he received through the air. Thus we fini 
persons frequenting water-closets where cholera 
patients have been, have contracted the disease. 
Tins was probably the way in which the farmer 
at Theyden-Bois, near Epping, first contracted 
the disease, which he carried from Weymouth to 
his home, and which produced such fatal effects 
in his family. 

In one of the cases at Southampton, bo ela- 
borately detailed in the report of the Medical 
Officer of Health of the Privy Council, 
found that one of the persons who died had 
been engaged the day before in attempting to 
unstop with a stick a public water-closet which 
had got blocked up with feculent matter. In a 
large number of cases the breaking out of cho- 
lera in an uninfected district has been clearly 
traced io persons coming from infected districts. 



x°« 



111 ill 



chi 
iut 

lie 



31 

Take the followir. | ^ liat when ^ 

A boy aged 8 year H "f^JT °PP°sed. 

the 7th of August 6 ^ S^ of fl ny 

ill of cholera, to s * | J^ ' 

uninfected street at '^ 

He was attacked w; a ■% 
Friday, the 9th of A 
uncle, who had not b 
trict, had the disease 
August. This could nfitdly he a coincidence, 
and could be explained on no other theory than 
the hoy bringing the disease from a place where 
it existed, and communicating it to an indi- 
vidual where tha disease had not previously 
been known. 

Another set of cases, which show the conta- 
giousness of cholera, are those in which persons 
who wash the clothes of those who have died 
of this disease have been seized with cholera. 
All these instances seem to prove that the 
cholera poison may be conveyed through the 
air as a medium. Another curious set of cnse3 
are those on which the dried excretions of 
cholera patients are carried by draughts of air 
into buildings and other places in contact with 
A surgeon in India relates, that on one 

jcasion after tiie existence of cholera in a pav- 
icular district four European sal4w.t% >sb.<i 1mA 




M, were attacked with cholera, 
i thus attacked had their heds 
i of two open doors which were op- 
other in the hospital. The only 
of this circumstance was to be 
i fact, that the dust from the out- 
i copiously blown in by a wind during 
the night, and that this dust contained the 
dried excretions of persons who had been known 
to be attacked with cholera, and who had, after the 
manner of people in the East, deposited their 
excretions on the ground in contiguity with the 
hospital. 

The poison of cholera may he easily" conveyed 
by the hand to the mouth. Thus where atten- 
dants are not cleanly al\er attending to the wants 
of those diseased with cholera, and not careful 
of washing, they may, by placing their fingers in 
their moutliSj convey the poison to their mucous 
membranes. Food taken by persons thus c 
cumstanced may be poisoned, and produce the 
disease. Even the affectionate embrnces of 
relatives, when parting with dying friends, may 
carry the poison of one mucous membrane to 
another, and thus produce the disease. 

But of all the means by which this poison 

may be conveyed, that by water seems the most 

constant and the most dangerous. 'I\iia mo&< 



THE POIBOX OF CHOLERA. 

of conveyance was bo novel, that when 
suggested it was almost universally oppo; 
Medical men had really no experience of 
contagious diseases that could be conveyed 
this way, and were incredulous as to the fa< 
In the first epidemic, of which we had any 
perience in this country, there were certain fact3 
which led to the supposition that it might be 
water that produced, in some way, a tendency to 
this disease. It was especially in London that 
this idea gained ground, aud an experiment, 
on a vast scale, seemed to have been performed 
on a district supplied by water from the Thames. 
When the cholera prevailed in London in 1848, 
the district of Lambeth was more afflicted in 
proportion to its population than any district in 
London. It was observed that this district was 
supplied with water by companies that derived 
their supply from below Battersea Bridge, and 
consequently from a part of the Thames pecu- 
liarly subject to contaminations from the sewers 
which emptied themselves into this river. This 
district was supplied by two companies, the 
Lambeth and the Vauxhall, which delivered their 
water throughout Lambeth in such a manoer, 
that each company supplied the same streets, 
and almost the same houses. At this time an 
Act of Parliament was -jsasseA fcWKS^Xv»% *^' 



^.Stoss. 



33 tij£ Poison of Cholera. 

water companies supplying London from the 
Thames to draw their supplies beyond the in- 
fluence of the tide from above Teddington Lock. 
Between the years 1848 and 1854 the Lambeth 
Company had opened its works beyond Teddiug-- 
ton Lock, whilst the Vauxhall Company i 
still supplied from its old source. When the 
cholera reappeared in 1854 it was found that the 
houses which were served with the water supplied 
by the Vauxhall Company suffered in the propor- 
tion of seven to one compnred with those supplied 
by the Lambeth Company. We think ther 
no other explanation of this extraordinary fact, 
than that the water of the river Thames b 
Battersea was contaminated with the poison of 
cholera, whilst that supplied from above Teil- 
dington Lock was free from this influence, 
give this instance as a proof that the poison from 
the excretions of human beings may pass into 
drains, and from drains into sewers, and from 
sewers into rivers, and thus disperse the poise 
to vast masses of a community. 

That the same influence may be conveyed 
from a water-closet to a well, is seen in the case 
of the people attacked at Theyden-Bois, near 
Epping ; hut the most gigantic case of this kind 
which has ever appeared in the history of epi- 
demic cholera, is that which occurred in the 



THE POISON OF CHOLERA. S3 

months of August and September, 18.5-1, in the 
parish of St. James, Westminster. Tins case 
demands attention, not only on account of its 
completely demonstrating the fact that the 
cholera poison may he conveyed by water, but 
on account of its showing that of all sources of 
unsuspected danger, the pump of a surface well 
may be mont fatal and destructive in its influences. 
In the parish of St. James, Westminster, is a street 
in the district of Gold en -square, known by the 
name of Broad-street. It is a wide street, and 
healthy, because it is wider than the height of the 
housesoneitherside. Inthisstreetstandsapump, . 
an ordinary street pump, connected with a well 
about 25 feet deep. The water percolates into 
Ibis well through a loose gravel extending for 
several hundreds of yards to its north and west. 
All this gravel is covered with streets and 
houses, and in it have been dug innumerable 
cesspools, and through it pass numberless drains 
— brick drains, rat-eaten, filthy, corrupt drains, 
and also sewers — bad sewers — some of them in 
the immediate neighbourhood of the pump ouly 
half a brick thick. Such drains and such sewers 
as only a country regardless of its health would 
tolerate. This purap in the year 1S51 was a 
piipular ptirop. From the soakoge i 
secretions, and their oxidation in the loose gravel 



M 



THE rOISON OF CHOLERA. 



the water was loaded with cooling salts and 
boaic acid gas, formed from the oxidized carbi 
human excretions, which made it lively to the 
and pleasant to the taste. It was a popular pum] 
just as the pump opposite St. Martin's chi 
is popular at the present moment, because of 
coolness and liveliness. At the latter end 
August, 1S54, a case of diarrhoea occurred i; 
house directly opposite the Broad-street pui 
It was the case of a child — it was only diarrl 
in a child ! No precautions were taken to 
infect this child's evacuations. All its excretii 

. were emptied into the closet, and there was 
one to inquire where next they might pass, 
the night of the 31st of August, there 
weeping and lamentation in all that distri 
The shadow of the angel of death had pas 
over it. The authorities were paralysed, the po 
lation was in dismay, lime was thrown on 
roads, and black flags hung at each end of Broai 
street. On the 1st of September tho Board 
Guardians met to consult as to what ougl 
be done. Of that meeting the late Dr. i 
demanded an audience. He was admitted, 
gave it a3 his opinion that the pump in Broad- 
street, and the pump alone, was the cause of 

all the pestilence. He was not believed — not a. 
r of his own profession not an m&wV 



ot a 



THE TOIBON OF CHOLERA. 



in the parish believed that Dr. Snow was right. 
But the pump was closed, nevertheless, and the 
jlagoe was stayed. Six weeks after, the vestry 
of St. James, Westminster, appointed a com- 
mittee to inquire into the origin of this sir 
and terrible outbreak of cholera. It was calci 
lated that upwards of 600 people, in a distri' 
not numbering 4000 souls, bad died in three 
days. The inquiries of this committee were con- 
ducted with the greatest possiblo precision. Oi 
it were several scientific men, and after three 
months' investigation of tbe most careful and 
accurate kind, they unanimously came to the 
conclusion that the water of the Broad-street 
pump was poisoned on the 31st of August, -and 
that the outbreak of cholera in the district 
Broad-street, Golden-square, depended satire]; 
on the poisoned nature of the water of that well. 
The evidence adduced was most circumstnntii 
and conclusive. It was shown that no conditio! 
of tbe atmosphere or the soil or the localil 
could in any way account for the outbreak of the 
disease. It was also shown most conclusively, 
by laborious personal investigation, that in a 
large majority of the instances of persons at- 
tacked or destroyed ly cholera that they bud drunk 
of the water of this pump. Itwo.5. 8jw&sffl»ta!!k*&. 
that, in a large factory iwfcdVj o^rtX» 



I 



\ 



Sfi THE POISON OF CHOLERA. 



fthe 



pump, the men who drank the water died of 
disease, whilet thosu who did not were not 
affected. The me,n who worked at a largo 
brewery close to the pump, who never drank the 
water, were none of them attacked. It was 
shown by a map that the greater number of 
those who died died in a circle round the pump 
and had drunk the water on the 31st of August. 
It was clearly demonstrated that certain persons 
lying beyond the circle of the pump had been in 
the habit of sending for the water of this pump 
on account of its popular qualities. A manu- 
facturer who lived near the pump was in the 
habit of sending a quantity of the water every 
day to his mother, who lived at West-end, Hamn- 
stead. She died of cholera, and a niece also 
who accidentally visited her and partook of the 
water. The evidence was most full, complete, 
and conclusive as to the relation of the disease 
to the taking of the water. When all these facts 
had been made out, the well was opened and 
examined, and it was found that a direct com- 
munication existed between the well and a cess- 
pool in the house in which the first case of 
cholera had occurred in the neighbourhood.* 

* Report on the Outbreak of Cholera in the parish of 
St. James, Westminster, in 1S51. London 
Churchill. 



John 



THE POISON OF CHOLERA. 37 

We now leave the question of Hie coutagiou: 
ness of the disease ; there can he no doubt of ii 
we think, after the evidence to which we havi 
alluded. It is still an interesting point fo: 
discussion as to whether the poison of cholera, 
after it has passed from the human hody, lias 
the power of increasing or multiplying so as to 
widen by a- living action independent of the 
human hody the sphere of its action. This 
question must of courso at the present time he 
problematical, seeing no one has succeeded 
isolating and experimenting upon the poison. 
Nevertheless there are some facts which euabh 
lis to speculate with tolerable certainty on the 
nature of this poison. 

In the first place, then, it appears that the 
poison retains its vitality for a long period of 
time. An instance is related in Edinburgh 
during the epidemic of 1848-9, that on its rt 
currence in 1340 a woman was sent down to 
receiving-house which had been shut up for 
several months, for the purpose of cleansing it 
and fitting it for the reception of fresh patients. 
This woman, without any communication with 
other cholera patients, came home from the 
house she had been cleaning with sympti 
cholera, and died in a few hours. 

German writers record cases Vu -sdi\cV\ Md w«a 



.he 

: 



!S8 THE POISON OF CIIOLEliA. 



>r of 
e in 
s the 

ltuml 
vour- 
r the 
loison 
ng i D 



as though the poison-germs had tlio power of 
multiplying anil growing when they came in 
contact with certain kinds of Boil. Thus I 
soil of cesspools null privies when thrown v. 
the ground for agricultural and hoiiicultui 
purposes, seems to hnve been peculiarly favour- 
able to the growth and development of the 
poison of cho?era. It seems as if the poison 
might actually traverse the air, and alighting r- 
theae appropriate beds like the spores of fungi i 
theair.could reproduce themselves and agai 
germs to the air. The occurrence of cholera i 
London in 1818 and in 1&54 in the neighbour- 
hood of grave-yards where the soil was recently 
opened, and in streets which were opened for the 
purpose of laying down gas or water pipes, led 
many eminent physicians, amongst whom may 
he named the late Dr. Ilodgkin, to suppose 
that the poison of the cholera found in this kind 
of soil a nidus on which it might develope itself 
and be diffused through the air around. 

The snmo theory has been proposed to account 
for the contamination of water. It is supposed 
that the quantity of poison passing from a 
cholera patient into a well or a river, would be 
so diluted that tiulcss it had the power of intilti- 



I plication, it would be impossible to account for 
the rapid and wide increase of the disease from 



THE POISON OF CHOLERA. 



39 



the drinking of impregnated well and river water. 
It may be as well to add that such a view as 
this is not at all incompatible with the known 
nature of the cells of the human body, of which 
the poison probably consists. The poison cells 
of small-pox are but changed cells of the same 
nature as those found in the human blood, and 
as no insurmountable objection exists to the 
supposition that even these may grow, as well 
as live out of the body, there is no reason why 
we may not apply this view to the explanation 
of certain of the phenomena of the communica- 
tion of cholera. 



THE CALCES OF THE 



CHAPTER V. 

I CAUSES OF THE TENDENCY TO TAKE 
CHOLEIIA. 

Whatever may be the exciting cause of < 
disease, whether it poison or some other exten. 
agent, it will always be found that some pel 
sons are more liable to take the disease tbf 
others. This is called predisposition. 
four men may le riding on the outside of u 
coach on a cold day, two will contract inflam- 
mation of the lungs, one will die, and the other 
get well, but the other two will not be attacked 
at all. The two first were predisposed to 
take the disease; the one who died more pre- 
disposed than the ODe who got well, but tho two 
who did not take the disease were not predis 
posed at all. So of two children exposed to tl 
poison of small-pox, one will take it, the otht 
not. On inquiry, we find that the one i 
did not take the disease had been vaccini 
The fact is, vaccination takes away the predis- 
po&ii/va to take small-pox. The same fttm 



TENDENCY TO TAKE CHOLERA. 41 

exists with regard to all diseases. In districts 
where cholera prevails, we find that it is only a 
certain number of persons who take the disease. 
This number varies in different localities. 
Lamentable instances have occurred where 
almost all the individuals living in a particular 
locality have been seized, and other instances 
occur where the disease is introduced aud only 
a few individuals take the disease. The stronger 
the predisposition to take the disease, the more 
liable the person is to die; and instances are 
constantly occurring in crowded neighbourhoods 
where only one family is attacked, and every 
member of this family will perish. It is there- 
fore of considerable importance to ascertain 
what are the conditions that favour the develop- 
ment in the human body of a predisposition to 
take cholera, 

Now, there are four things which are more 
especially necessary for the maintenance of the 
body in good health, in a state in which it will 
not be predisposed to take any disease. These 
are, fresh air, pure water, good food, and warmth. 
The deprivation of any one of these four may 
engender a state of the system in which it will 
be predisposed to take cholera, or any other 
disease. We will now briefly ctlmbmib "Oft* c 
ditions under which these &gen\& w& Q,A - 



vidt 
deli i 

seve 



THE CAUSES OF THE 



presei 
certain 



vidtmls, for the purpose' of showing how their 
deficiency may iuvite the action of the poison 
cholera. 

Freak Air. — An atmosphere composed of 
nty-one ports by weight of oxygen, and 
seventy-nine parts of nitrogen, is necessary to 
the existence of every animal being ; alter these 
proportions, and disease is the result. The pro- 
visions for the maintenance of these properties 
in our air are so perfect, that we seldom find 
them disturbed, Even iu our overcrowded 
towns the constituents of the atmosphere re- 
main the same. It is not then in the changed 
proportions of the grand constituents of the 
atmosphere that we must look for an influence 
on the system producing a predisposition to 
disease, but in the quality of these constituents 
and the presence of foreign substances. And 
first, with regard to quality: it is now above 
twenty years since, that Professor Schiinbein, of 
Bale, announced the discovery of an agent in 
the atmosphere, which he called ozone. This 
substance is now known to be a changed or more 
active condition of the oxygen gas of the atmo- 
sphere, It possesses nil the active properties 
of oxygen in a more intense degree, and its 
:esence may be detected in the atmosphere by 
ats on which it acta with \ 



TENDENCY TO TAKE CHOLERA. 

activity than ordinary oxygen. Ozone is found 
in the atmosphere in country districts, by the 
sea-side, and on mountain -tops, more espe- 
cially when the wind is blowing from the 
south or west. Its action on the system is 
highly favourable to health, and during its 
absence the human body exhibits a predisposi- 
tion to certain forms of disease. So evidently 
is this the case, that certain writers have un- 
hesitatingly referred a predisposition to take tbo 
cholera poison to an absence of this agent. 
During the prevalence of cholera in London in 
18.18 and in 1854, a great deficiency of ozone 
was observed, as indicated by the test papers 
ordinarily employed for detecting this agent. 
The same observations have been made in India. 
Dr. Cook, who has reported on the subject of 
" Ozono" to the government of Bombay,* states, 
that on one occasion he was riding away from 
the station of Ahuiednugger, having left his 
wife residing there, and he was struck by the 
slight influence the atmosphere was exerting on 
the ozone test paper which he usually carried in 
his hat. So important did he consider this 
phenomenon, that he sent a messenger to warn 
his wife, to request her to lease tioft -sJueSw,-^- 

■ "Sanitary Notes," by 3. JVSa&S^Mfc 3°* T,ial ** 
/MdMm. September, 1866. 



44 THE CACHES OF THE 

In tliree days cholera broke out with greir 
virulence, and raged in and around the canton 
mcnt for some period. Now, it is not suggested 
that the unozonised air conveys the cholera 
poison with more facility, but that an atmo 
sphere destitute of ozone renders the systei 
more susceptible of the action of the choleraic 
poison, that is, predisposeB the system to attacl 
of cholera. There are many ways by which this 
action could be explained, but we think it suffi- 
cient to indicate the facts ns they have been given 
by competent observers. 

In the next place the air is subject to the 
introduction of foreign agents, which exert 
depressing influence on the system. Thus tin 
atmosphere contains varying quantities of moii 
turej and it has been found that both excessive 
dryness and excessive moisture exert a depress- 
ing influence on the system, and both conditions 
have been recorded as favourable to attacks of 
cholera. Over this and the foregoing agen 
man has but little power when tlicy exist gene- 
rally in the atmosphere of a district. It is ovei 
the existence of what may be called foreign 
agents that man has most influence. 

Thus, carbonic acid is being constantly poured 
into the atmosphere from the lungs of human 
beings and other animals and from candles and 
gas. Naturally this gas is speedily 



jra 

: 

nic 
:k, 
his 
S- 
en 



TENDENCY TO TAKE CHOtERA. 



45 



throughout tho whole atmosphere; but when 
human beings are kept in close rooms, and 
even in close streets and alleys, this gas may 
accumulate to nn extent to exert an injurious 
and depressing effect upon tho system. Car- 
bonic acid gas, which is formed in the blood 
of all animals during the processes of life, is s 
decidedly a poison that an animal prevented 
from throwing it out from its luugs dies in the 
course of three or four minutes, as seen in the 
processes of bunging and drowning. Ono of the 
great evils of our civilization is the crowding of 
men and women into close rooms, where their 
systems are constantly exposed to the action of 
this gas. Persons thus situated are known to 
become the subjects of scrofula and consump- 
tion, two of the greatest scourges of civilized 
litunnii beings. Thero can be no doubt that 
where human beings are constantly exposed to 
the action of this agent their system becomes 
depressed, and they are predisposed to take tho 
poison of cholera. It has always been in the 
close, low, unventilcited buildings of our great 
towns that cholera has prevailed to the greatest 
extent. Such places do not generate cholera; 
tbey offer a fitting means for the diffusion of 
the poison, and it is in them that those persons 
dwell whoso systems are mast s' 
fiction of the poison o£ eVicAeia. 



4G THE CADSE8 OF THE 

The air of close and unventilated 
also exposed to many exhalations from the 
bodies of human beings, and from the various 
things in the room. These matters are quite 
impalpable; but they collect especially on the 
glass windows of such rooms, and can he re- 
vealed to the curious by the aid of the micro- 
scope. They consist of cells of decaying animal 
and vegetable matter, which frequently afford a 
nidus for small living beings to live upon. Such 
particles taken into the lungs interfere more or 
leS9 with the absorption of oxygen into the 
system, and have a tendency to produce those 
changes in the vital organs which make the 
system predisposed to yield to the action of the 
poison of cholera, and to increase its influent 
when once established. 

All these facts with regard to the nature of the 
influence of the atmosphere on the system point 
to the necessity of cleanliness and ventilation. 

2. Pure Water. — We have spoken of 
agency of water in convoying the cholera poison, 
hut quite independent of this action water may 
exert an injurious effect upon the system, and 
render it predisposed to attacks of cholera. 



he 

„ 

be- 
nt 

tho 
ion, 



Water, as supplied to our towns, is seldom pure. 

bit is derived principally from two sources, from 
rivers and from wells. Under these circnm- 






TENDENCY TO TAKE CHOLERA, 



it is constantly impregnated with sail, 
or mineral and organic matters. A few grai 
of saline matters in the gallon of a 
similar to those contained in the blood are not 
injurious; but very small quantities of sub' 
stances not contained in the body, as lend, will 
act injuriously. A quantity of saline matter, 
exceeding forty grains in tho gallon, shoult 
render a water suspicious, and where purgati 
salts ore found in water, as Epsom salts, Glaubi 
salts, and others, there is no doubt their present 
may lead to a state of the bowels which wouh 
predispose to the reception and fatal activity 
the cholera poison. 

It is, however, the organic impurities of wai 
that are most likely to act injuriously on 
the system. They are derived from the decom- 
position of anim al and vegetable substances, am 
may be derived from living organis 
matters introduced from the sewage of houi 
Unfortunately, both our river and well waters 
liable to this latter contamination. The qualit; 
may be easily tested hy what is called the pi 
mangannte test. A few drops of a solution 
permanganate of potash (one grain 
ounce) may be used for this purpose. If tl 
permanganate loses its colour in the water ii 

itains organic matters. An equal quauti 



i 

lity 



48 THE CAOSES OF THE 



of water of known purity may be employed i 
testing, and the difference in the colour of 
two will indicate tlie amount of organic impurity 
Water may be very bright when drawn and yet 
be charged with a considerable quantity of 01 
gauio matter. In the summer, when such wat< 
contain less oxygen, they are liable to beco: 
putrid, and on being taken, to irritate the boweli 
and in tins way predispose persons to recei' 
the poison of cholera. 

In the summer especially, and at all seasoi 
when cholera is prevailing, it is a safe plan 
boil water, and when cold to pass it through a 
filter before drinking it. The surface well* 
pumps of Loudon are especially liable to con- 
tamination, and on this account ought to he 
avoided. Even in the country, away from 
large towns, a practice exists of placing tho 
cesspool witbin a few yards of the pump; aud 
should any leakage take place from the former 
to the latter the consequences to health may be 
at all times disastrous, but when cholera prevails 
may he fatal. 

3. Good Food. — There is no proper nourish- 
ment of the organs of the body without good 
food ; and unless the organs are properly nou- 
rished there will be no sound health, nod the 
body will be predisposed to take disease. Cholera 



I 



TENDENCY TO TAKE CHOLERA. 49 

is not like relapsing fever, a disease of famine, 
hut where famine prevails in a district there 
cholera will be most fatal. It is amongst the ill- 
fed portions of our population that we find this 
disease slaying the largest number of victims. 

The question may be asked here as to what is 
good food, so that this need may be supplied. 
Food serves two purposes iu the system ; first, it 
maintains the heat of the body, and secondly, 
it renews the flesh that is wasted by the action 
of the nerves and muscles. The first action is 
produced by starch, sugar, and fat ; the second, 
by albumen and fibrine, which are contained 
in bread and the flesh of meat. In bread wo 
have starch and fibrine, a heat-giver and 
flesh-former. In butcher's meat we have fat 
and fibrine, a heat-giver and flesh-former. In 
vegetables we have certain mineral matters which 
are also necessary for the nutrition of the body. 
In all good food there should be these agents. 
In addition to these kinds of food man takes 
certain nervous stimulants with which ho flavours 
the hot water which he finds necessary to take 
into his system. These are tea, coffee, and 
cocoa, A good breakfast consists of bread-and- 
butter, bacon and eggs, and hot tea, coffee, or 
cocoa. A good dinner consists of a slice of 
meat, with bread and potatoes or other vege- 



60 THB CAUSES OF THB 



reoei 



tables. A good sapper consists of bread. 
milk, or bread and cheese, with coffeo or cocoa. 
Of course this diet can be varied, and the sub- 
stantinls cooked in a hundred different ways ; 
but some people are at a loss to know what is 
meant by good food, and think that unnecessary 
luxuries should enter into its composition. Now, 
it is not amongst those that live on the food we 
have mentioned that predisposition to cholera is 
produced. The food, however good, may be 
deficient; and from this cause a feebleness of 
the system is produced whioh invites attacks ol 
cholera. 

The food amongst the lower classes is 
of an improper kind and not fresh. When 
kind of food predominates over another jt pro- 
duces unfavourable results in the system. Thus 
potatoes, when made a substantive article of diet, 
as they contain too little nutritive matter, often 
lay the foundation of predisposition to disease. 
Disproportionate quantities of other vegetables, 
as carrots, turnips, and potatoes, produce dis- 
order of the bowels. On the Continent weak 
soups are often taken by the poor people in 
large quantities, and render them predisposed to 
attacks of cholera. In Russia there is a taste 
for taking these soups with ice, and people were 
recently warned of the danger they ran. In 



coa. 



■s ot 



TENDENCY TO TAKE CHOLERA, 






1832, Dr. Tytler pointed out that damaged [rice 
eaten by the natives of India was a source of 
predisposition to cholera, and he was inclined 
to attribute the cholera in Europe to the use of 
this damaged rice. Whether this was the case 
or not, there is no doubt that food of any kind 
in a state of decay is a source of derangement 
to the bowels, and invites in the system attacks 
of cholera. Numerous instances are recorded 
in which persons have been attacked with cholt 
soon after eating meat or fish which hi 
way become tainted. Milk is very liable 
become sour, which is the result of a change 
which is highly prejudicial to health, and there 
can be little doubt that a large amount of the 
summer and autumu diarrhoea of this country, 
which is often so fatal amongst children, is due 
to the use of sour milk. Hence we comprehend 
under the name of good food not only food that 
is right in quality, but such as is sound 
free from taint of any kind. 

Under the head of food we must include bei 
wines, and spirits. These alcoholic drinks 
consumed extensively amongst the inhabitants 
of Europe, and whilst there is no evidence to 
show that the moderate and temperate taking 
of these beverages is injurious to health, there 
is abundant proof that the excessive indulgence 
D 2 



■ 

ice 



tcks 
■ded 

z 

I to 
.nge 
lere 
the 

due 
end 
that 
and 

■ens, 
are 



52 THE CAUSES OF THE 



in them is one of the most fertile causes of 
a predisposition to take cholera. It lias been 
abundantly proved by the practice and expe- 
rience of teetotallers that beer, wine, and spirits 
nre not necessary to a healthy existence. There 
is no evidence to show that persons who drink 
nothing but water are more liable to cholera 
than those who drink alcohol. It is true, 
that where persons ore exposed to the drinking 
of poisoned water, then those who drink nothing 
hut water are more likely to be attacked than 
those who drink nothing but beer or wine. It 
appears that those who drink spirits and water 
are equally exposed with teetotallers, as the 
spirit does not appear to destroy the poison- 
germs of cholera in water. Whilst raw spirits 
act so injuriously on the coats of the stomach 
that it may be questioned which is the most 
dangerous poison, that of cholera water, 
ardent spirits, 

4. Warmth. — Even in our hottest summers 
exposure of the person to cold will generate 
disease. Instances of sudden attacks of cholera 
have been known to take place by persons riding 
for long distances on the outside of coaches, or 
otherwise exposing themselves to cold. In the 
autumn of the year when cholera has most fre- 



■ 

n 



its 
ch 

)S t 

■ 

?rs 
ite 



quently visited this country, although the dayB 



TENDENCY TO TAKE CHOLEEA. S3 

are hot the nights are cold, and exposure to 
the cold of night with insufficient clothing is 
calculated to invite an attack of cholera when 
the poison is present in any particular district. 
It seems very important that the ahdornen should 
be kept warm, hence the very general recom- 
mendation of those who have seen an epidemic 
of cholera that persons should wear during the 
prevalence of cholera extra clothing, or at any 
rate a flannel waistcoat. 

5. Sex and Age. — The influence of sex and 
age on the predisposition to cholera varies. It 
is, however, very certain that persons of adult 
age are more liable to the attacks of this disease 
than children. During the present epidemic in 
the east of London this has been observed. In 
the week ending August 4th it was found that 
there were 1003 cases of cholera; of these 457 
cases occurred in children and 500 in adults. 
In an attack of cholera experienced by our troops 
in Canada, the following is the ratio pet 1000 
of those who died ; — 
Years. 
From 18 to 25 . . . 15 in 1000. 
„ 85 to 33 ... 23 
„ 33 to 40 . . . 30 „ 
„ 40 to 50 . . . 70 „ 

- — 



54 THE CAUSES OF THE 

towns that women ore more subject to tbi: 
disease, or it is more ftttal to them than m< 
Of 145 fatal cases in Sunderland, 63 were mail 
nnd 82 were females. 

It appears that the black and coloured raci 
of mankind are more predisposed to take tl 
cholera and to die with it than the whits 
races. As far as returns go from various 
parts of the world this is home out. In Hin- 
dostan the natives are certainly much more 
liable to the disease than the Europeans, and 
suffer proportionately. The slave population 
of South America, have always suffered very 
severely when the disease has been introduced 
amongst them. 

The number of persons attacked by cholera 
in a community has always varied very much, 
and this has evidently depended on the amount 
of energy and intelligence brought to bear on 
the taking of means for its prevention. There 
is undoubtedly a limit in every community 
beyond which it cannot go. What that limit 
it would he impossible to define ; but as with 
other contagious diseases so with cholera, there 
are some persons who have absolutely no pre- 
disposition to take the disease. The reason 
why these persons do not take the disease we 
cannot say ; but they form the natural barrier 



i 
i 

B 

1 
- 

I 








TENDENCY TO TAKE CHOLERA. 55 

against which the waves of contagion surge in 
vain. They constitute the means which Provi- 
dence employs to prevent the destruction of the 
whole human race by any plague. 

A French writer gives the following table of 
the number of persons attacked in the different 
countries of Europe : — 

France I in 300. 

Russia 1 in 20. 

Austria 1 in 30. 

Prussia 1 in 100. 

Belgium 1 in 120. 

Great Britain . . . 1 in ISO. 

Holland 1 in 14J. 

Germany .... 1 in 700. 

From the [foregoing remarks it will 1 
that a variety of external causes act upon the 
system, and engender in it a liability to take the 
poison of cholera; hut these things must not be 
regarded as the true cause of cholera. They 
may exist in the utmost intensity, and will never 
produce true epidemic cholera. This comes by 
the agency of a poison which is brought to the 
abodes of those who have not fresh air, pure 
water, good food, or warm clothes. This poison, 
in spite of the presence of all these agents of 
health, will now and then smite down the 



06 TENDENCY TO TAKE CHOLERA. 

apparently healthy, the cared for, and the 
wealthy ; hut it does not spread amongst them. 
The doctor occasionally dies, the nurse is 
smitten at her duties, the clergyman or the mis- 
sionary are seized ; hut the disease does not 
spread in their houses, where the poison is diluted 
by abundance of fresh air, and all the appliances 
that intelligence can employ are made use of. 



CHAPTER VI. 

HOW CHOLERA POISON IS CONVEYED. 

In the preceding remarks we liave had to an- 
ticipate much that might properly be said under 
Uiis head. The great means hy which the 
cholera poison is conveyed, are obviously the 
air, water, and personal contact. 

1. The Air. — The great means by which the 
poison of scarlet fever, measles, typhus, and 
small-pox are conveyed, is through the air. In 
these cnses the disease affects the skin, and from 
the surface of the skin the infecting poison i3 
carried to the lungs through the air. The dif- 
leruiii'o between cholera and these diseases is, 
that the cholera affects the mucous memhr 
of the alimentary canal, and the poison is there 
produced. It is, therefore, much more likely to 
be conveyed hy water, hut just as scarlet fever 
poison may be carried by water though its 
natural agent of diffusion is the air, so the 
poison of cholera may be diffused through the 



58 HOW CHOLERA POISON IS CONVEYED. 

air. There is reason to believe that the poison 1 
fumes of cholera may immediately escape into I 
Um «ir from the evacuations, and the case o 
persons taking the disease in carrying or washing 
the linen of the diseased, or in attending upon 
them, seem to indicate this fact. There are also 
facts that seem to show that where cholera excre- 
tions have been allowed to dry upon the soil, ex- 
posod to the influence of the sun, that a draught 
of air or breeze may blow the dried excretions of 
the soil into the residences of human beings, and 
thus communicate the disease. 

It is, however, very questionable as to whether 
the poison is of a nature to diffuse or propagate 
itself in the air. We are greatly indebted to 
Mr. Glaisher, of the Koyal Observatory, Green- 
wich, for his careful observations on the meteoro- 
logical conditions which accompany cholera 
visitations, and be has lately described a "blue 
mist" which he snw in 1W54, and which has 
again appeared in 180(1. This observation is 
very interesting, and if it were found that this 
mist existed in greatest abundance when cholera 
breaks out, and that it contained matters which 
could in any way be made to produce cholera, 
it would bo highly important. At present suf- 
ficient is not known of this agency for us to be 



■ 



BOW CHOLERA POISON IS CONVEYED. 59 

able to pronounce that it has any connexion 
with an outbreak of cholera.* 

2. Water.— The cases referred to, when wa 
were treating of the poison of cholera, are 
sufficient to show that water is a more common 
medium for the diffusion of the cholera poison 
than air ; and we see how this^swheu we consider 
that the contents of the bowels naturally come 
in contact with water in the soils orrivers where 
they find their destination. This fact is of the 
almost importance, as it alone explains the 
cause of those sudden, irresistible, and devas- 
tating outbreaks which occur iu the midst of 
the cities of Europe. To say nothing of the 
present outbreak iu the east of London and of 
others in many parts of England and the con- 
tinent of Europe, let us once more draw atten- 
tion to the two great typical cases — the out- 
breaks in Lambeth in 1848 and 185-1, and 
the outbreak in Broad-street, Golden-square, iu 
1854. Both these causes are so conclusive as 
to the water of the Thames and the water of 
the Broad-street pump causing the cholera, that 
no other theory is at all tenable. The water of 
the Thames which supplied Lambeth was e 
posed to cholera evacuations from the drai 
• Sec Appendix A. 



res 



60 HOW CHOLERA POISON IS CONVEYED. 

and sewers of London ; the water of the Broad- 
street pump was exposed to the contents of a 
cesspool in a house where a person had been 
attacked with cholera.* 

The practical lesson to be derived from this 
knowledge is the fact that no community is safe 
from cholera that ii dependent for its supply of 
drinking-water on rivers receiving sewage, or 
on wells that may communicate with drains, 
cesspools, or water-closetB. Now, this is an 
alarming statement, but it must be looked in 
the face. A question here arises as to whether 
it is so far possible to dilute the poison of 
cholera as to render it comparatively innocuous. 
Reasoning by aualogy, we may suppose that 
cholera poison may be diluted in the water just 
as typhus fever poison is diluted in the air. We 
know that a typhus fever patient may be so 
placed that the poison which escapes from his 
body shall be so thoroughly diffused that it will 
not attack another person. Now this is possible 
with the cholera poison ; and it may be that 
even should Reading or Oxford suffer from 
cholera that the poison of their sewers will not 
reach London. There is even good grounds 



Report on (he Cholera Outbreak iu St. James, 
estminstcr, 1854." Churchill. 

the Communication, of Cholera." Ej John Snow, 
JI.D. Churchill. 



for believing that it would not. Water when 
exposed to the air absorbs oxygen, and always 
contains considerable quantities of this gas. 
Now, as long as the organic matters are not in 
overpowering quantity, it is the property of this 
gas to oxidize these matters, to destroy their 
putridity, and to prevent their becoming inju- 
rious to man. It is from this cause that river- 
waters, which receive considerable quantities of 
sewage matter, have been found free from or- 
ganic contaminations. 

It is not, however, well that people should 
depend on such an agency for the purification 
of those rivers from which drinking-water is 

I derived, and where there is the least suspicion 
of the conveyance of so dreadful a poison as 
that of cholera every precaution Bhould be taken. 
It is well known that most animal poisons are 
destroyed at the temperature of boiling water, 
and this offers a BJmple means of rendering un- 
injurious any suspected water. A more effectual 
way of purifyiug water has been recently and 
strongly recommended by Professor Frankland, 
and that is, of passing it through animal charcoal. 
If water then is first boiled, and then filtered 
through a filter composed of animal charcoal, 
it may be taken with impunity. 

3. Contact. — There can be no doubt that 
amongst those who are habitualVj ■ns$\^&. <A 



HOW CHOLERA POISON IS CONVEYED. 



ft] 



62 HOW CHOLERA POISON IS CONVEYED. 

personal cleanliness, direct contact with the 
poison from the mucous membranes of such 
persons is a constant means of communicating 
the disease. Persons attending upon the sick 
perform for them offices which must necessarily 
bring their hands in contact with the poison ; 
and if they are not careful to wash and use dis- 
infectants, they may easily by taking food, or 
by other means convey their hands to their 
mouths, and thus swallow enough of the poison 
to render them liable to an attack of the disease. 
This leads us to observe how thoroughly neces- 
sary is absolute cleanliness. It is the cleanli- 
ness of those who nurse and attend upon the 
sick in our great hospitals that spares them from 
the attacks that so often fall upon those who are 
careless of their persons and ignorant of the 
laws of this disease. 



CHAPTER VII. 

BOW TO PREVENT CHOLERA. 

The preaeding chapters have been written with 
the view of giving information to the public on 
the nature of cholera, under the conviction that 
it ia only by an intelligent apprehension of the 
laws which govern the development of this dis- 
ease on the part of the great bulk of the com- 
munity, that we can ever hope to proveut its 
appearance or arrest its progress when it has 
appeared. It must, thou, ho very evident that 
there are two things, or sets of things, to be 
done : — 1. To secure for ourselves and our 
neighbours such a state of bodily health that wo 
may not be predisposed to take the disease. 
2. To take all possible precautions against tho 
introduction of the poison of cholora. 

With regard to the first object to bo attained 
it has this advantage, that what is good against 
cholera is good against almost all other form3 of 
disease. 

One of the most essential things 



CI HOW TO PREVENT CHOLKKA. 



health is fresh air — air unadulterated with rar 
neral, vegetable, or animal impurities. It may 
not be possible for every one to obtain perfectly 
pure air, but every effort should be made to do 
so, and every one should reflect that ceteris pari- 
bus, the person who breathes the most fresh air 
will live the longest. All persons engaged in 
sedentary pursuits should strive to obtain fully 
two to three hours' exercise in the open air every 
day. Not only is the air beneficial, but the ex- 
orcise also. The heart, the lungs, the muscles, 
the stomach, the bowels are nil benefited by 
exercise in the open air. The air of the closest 
streets and courts in London is better than the 
air of close and ill- ventilated rooms. 

Next to exercise in the open air, the venti- 
lation of sitting-rooms, bed-rooms, workshops, 
schools, chapels, churches, places of amusement, 
should be attended to. In tbis operation two 
things should be regarded, — first, the getting 
rid of the bad air, the carbonic acid gas, and 
other impurities from within; and second, the 
letting in of fresh air containing oxygen from 
tcithout. Fires ventilate rooms in cold weather 
by drawing the air of the room up the chimney, 
and thus allowing air to come in from without. 
But all Tooms without fires should be ventilated 
hy letting down the top sash, of the window, or 



/ 



HOW TO PREVENT CHOLERA. 

ventilating panes in the windows or -valves in 
the chimneys. All these arrangements should he 
made so ns not to expose individuals to a draught 
of cold nir. A draught is occasionally unavoid- 
able for the purpose of ventilation, hut the want 
of fresh air is the greater evil of the two. 

The overcrowding of rooms should be avoided. 
In either sitting-rooms or bed-rooms wjiero 
there are lens than 500 cubic feet of space to 
each individual, the room may he regarded as 
overcrowded- It is in the overcrowded rooms oF 
the poor of London that cholera and other dis- 
eases find the largest number of victims. 

In order that the air of a room may he fresh 
everything in it should be clean. Dirty walls, dirty 
floors, dirty carpets, dirty beds, dirty curtains, 
dirty clothes, and dirty skins, all contaminate 
the air and render it unfit to breathe. A room 
should have no smell, and directly any un- 
pleasant smell arise its source should be dis- 
covered and removed. Dwelling-rooms should 
be whitewashed at least once in the year, and 
oftener when obviously dirty. The floors of 
rooms and stairs should he scrubbed onci 
week. Hugs and mats should he beaten every 
two or three days. Better to have no carpets 
than dirty ones. Bed-ciirl.ains should be dis 
pensed with. They are a nuisance when clean. 



CO HOW TO PREVENT CHOLERA. 



and n source of disease when dirty. Bed- 
should be changed once a fortnight, and bed 
steads taken down and cleansed ouce a year at 
least. Dirty slops should bo at once emptied 
out. 

Personal cleanliness should be secured by 
washing and bathing. Children should be 
washed at home from head to foot at least once 
or twice a week. Grown-up persons, male and 
female, should bathe frequently. In all our 
large towns there are baths which can be made 
use of at a low price by the poor. 

Bad smells may arise from many sources out- 
side the room, and should he looked after. 

Dust-bius or ash-pits arc receptacles neces- 
sary for the cleanliness of the bouse, but 
they never ought to smell. They should be 
emptied at least once a week. They frequently 
smell on account of the lazy habit of servants 
and housekeepers of throwing in with the cinders 
and other dry dust vegetable and animal refuse. 
All such things, if not otherwise made use of, 
should be thrown on to the fire. In all our 
large towns there are dustmen, who are com- 
pelled to remove the dust whenever called upon 
to do so. 

In all cases water-closets should havo a con- 
stant supply of water. It should be rememherei 



linen 
bed- 



■ 



HOW TO Pit EVENT CHOLERA. 07 

that every closet which lets water down to a drain 
may allow bad air to come back, so that the traps 
should be looked to regularly and kept well 
charged with water. Privies should be placed 
at some distance from the house, and the seat 
should be constantly covered and ventilation 
secured through the door. When contagious 
diseases of any kind exist in the house, some 
form of disinfectant should be thrown down 
every day. Cesspools should not he emptied in 
hot weather. 

The drains of houses should be constam 
looked to, as when improperly constructed or 
not trapped, they may allow dangerous emani 
tions to escape into the bouse. 

Oil''. 1 ii si ve businesses in crowded neighbour- 
hoods, such as the keeping of cows, horses, 
pigs, poultry, or other animals, the slaughtering 
of animals, the boiling or storing of grease or 
other animal matter, are all liable to indictment, 
and when such businesses are productive of bad 
smells and injuro health, they should be got 
rid of. 

All these sources of bad smells and inji 
to health may be dealt with by law. It 
the duty of the landlord, with regard to the 
great mass of the bouses occupied by the poor 
of England, to attend to the cleaning of 



I 



Sot 

■i-T 

[t is 
I the 
poor 

: &» 



08 HOW TO PELVEST CHOLERA. 

house, and the state of the drains and 

water-closets. Wherever the local authorities are 
called upon to net, they should take perms 
iioder tho " Nuisances Removal Act," which is 
not only operative for London and the largo 
towns of England, but for the country. Many 
of the evils arising from these causes which ex- 
pose the populations of our small towns and 
villages to attacks of cholera are removable by 
tho application of this Act. The "Sanitary 
Act of 1BC0" is more stringent still, and gives 
great powers to local authorities for the removal 
of all nuisances productive of disease. It is to 
he hoped that medical men, clergymen, and the 
wealthy inhabitants of our rural districts will 
feel that the health and lives of a large number 
of their fellow- creatures are dependent on their 
public spirit, patriotism, and Christian charity, 
in carrying out Acts of Parliament which have 
been passed to cure evils which deeply oppress 
and injure the poor population of this country. 

We next come to water, and on this subject 
so much has been said that it can only bo neces- 
sary to repeat here, that one great means of 
maintaining the health of a community is the sup- 
ply of pure water. It is, however, not only neces- 
sary to have a source of pure water, but as in 
many cases thi3 water has to bo stored, it 



HOW TO l'REVENT CHOLE] 

necessary to look to the storage. It would be 
better if this could be done by the water company 
and the water supplied constantly, but at present 
this is out of the question, and one thing we 
ought all to do is to look to our cisterns and 
water- butts. Cisterns and water-butts are too 
often neglected. They aro frequently situated 
where the effluvia from water-closets and dust- 
bins pass directly into them, and the water is 
thus contaminated with sewer gnses. They 
should always be covered, and at this*season of 
the year should he emptied and washed out at 
least once a mouth. Quicklime should be used 
to cleanse the bottom, and wooden butts should 
be fresh pitched at least once a year. Where 
water is liable to contamination permanganate 
of potash may he added till it begins to tinge 
the water. The permanganate effectually < 
st.roys organic matter. 

Wo have before spoken of the importance of 
boiling aud filtering water before drinking it in 
seasons of epidemic cholera. It is not often 
that poor people can buy filters, the demand for 
tliem is not yet great enough to induce the 
earthenware manufacturer to produce a cheap 
one. In the absence of one ready made, 
filter can be extemporized by taking a pail c 
icket, placing it over two pieces of , 



70 HOW TO FREVEST CHOLERA. 



T-pot 



then standing over it a common flowei 
The hole Rt the bottom of the flower-pot should 
bo plugged with sponge, and then into the bottom 
is to be placed a layer of animal charcoal, not 
in fine powder, but in large graics like OMUH 
salt or gunpowder. Over the- chare 
to bo laid a layer of sand nnd pebbles to keep it 
down, and water poured into it and allowed to 
filter through into the pail below.* 

We now come to the question of how to pre- 
vent the introduction of the cholera poison into 
a country, a town, or a house. With regard to 
a country, this can only be done by the actiou 
of the Government, and by quarantine lawa. 
There has been so much oppression carried on, 
by the Governments of Europe through quaran- 
tine laws, that liberal politicians have been 
nnxious to diminish their severity, and have 
hesitated to introduce new ones. Our own 
Government has in particular been tardy to 
enforce any restrictions on the commerce of this 
country for the sake of preventing cholera. 
Hence it has found its way to our own seaport 
towns almost as soon as possible. Tims it was 

* Such a Alter was to be seen fa the food collection at 
the South. Kensington Museum when that institution was 
conducted with the object of inttnteting the people ia 
what concerns their daily welfare. 



HOW TO PREVENT CHOLERA. 

at Southampton and Liverpool in 18G5, and hat 
probably thus found its way to London in 18 
When once the poison has found its way into a 
country it is most difficult, to check its progi 
by quarantine. Nevertheless, every reasonable 
precaution should he taken. The Legislature 
lms in fact provided for extra powers being given 
to local authorities when an outbreak of cholera 
is anticipated. The following instructions have 
been recently issued by tlie l'rivy Council :- 



When Cholera is in a Parish or Districl. 
. . Every vestry or board shall make arrange- 



ments for meeting, where the disease is actuall; 
prevailing, daily, either in a body or in one t 
more committees, according to the exigencies o 
the parish or district, for the purpose of exercising 
the powers conferred upon them by the Act. 

2. The meetings may ba held at the ordini 
hoard-room, and where necessary at such otbei 
places as shall appear to be most convenient for 
dealing with the disease, and the vestry or board 
shall cause proper minutes of all proceedings t 
be made and duly recorded. 

3. The medical officer of health shall, as far 
as practicable, attend the meetings of the v 
or board, and of its committees, to render 1 
advice thereat, and shall s^ermi 



72 HOW TO TREVENT CHOLERA. 

medical nrrangements fur preventing and Irei 
ing the disease. 

4. Ill each parish or district in which clioli 
is preBeiit, or, if the quantity of work to 
renders it desirable to subdivide the parish or 
district, then in each of such suh divisions, a 
legally qualified medical practitioner shall 
put in charge of the parish, or district, or sul 
division for the medical purposes of these re; 
lations; and to each such medical practilioi 
(hereinafter named the medical visitor) shall 
allotted such assistants as the vestry or hoi 
see fit, 

Such medical visitor, where practicable, or 
other cases one of his assistants, shall at 1c 
onco daily visit those places assigned to hi 
which are inhabited by the poorer classes ai 
wherein the disease is, and shall there inqnire at 
every house as to the existence of diarrhoea or 
cholera, and shall enter in a book to he kept ft 
the purpose the facts as to all cases he may mei 
with, and shall without delay give, or take tl 
proper steps for causing to he given, all neces 
sary medical assistance to the sick. And the 
medical visitor or assistant shall, when visiting 
the places assigned to him, be provided 
medicines for immediate administration in urgei 
md shall be held to be in medical chi 



I 

lit A 



; for 
licet 

u. 

CC3- 

the 
ting 

Kith 

<>>;■ 



HOW TO PREVENT CHOLERA. 



0/ all cases of diarrhoea or cholera with which lie 
may meet until he is relieved by such other 
provision for their medical attendance as may be 
made or sanctioned by the vestry or board. 

5. Such medical visitor shall, by transmitting 
his above required book, or otherwise, report 
daily to the medical officer of health the result 
of his own and his assistants' inquiries, and shall 
report any nuisances which ho or they find exist- 
ing in any premises visited by him or them, and 
shall make such suggestions as to the state of 
the parish or district as he shall deem advisable. 

0. The visitors shall, where they find it expe- 
dient, communicate to the relieving officer of the 
district any case of destitution requiring relief, 
which is not entered in his relief list ; and such 
officer shall forthwith visit the same, and give 
such relief as in bis judgment the case shi 
require. 

7. The vestry or board shall provide a suf- 
ficient number of dispensaries, to be open night 
and day, at convenient places within their parish 
or district, with an adequate supply of audi 
medicines, medical appliances and disinfectanl 
as their medical officer of health shall 
mend, and with a legally qualified medical prac- 
titioner or skilled assistant always iu attendance 
; each; and such medicines, m.ei\ta.\. w^jK.- 



I 



icli 
ive 

I 

[M 

sh 



HOW TO TREVENT CHOLERA. 



ances and disinfectants, shall be dispensed wii 
out charge by such medical practitioner 
assistant to persons bringing orders for the sai 
from the medical visitors, and to other persons 
who apply for immediate medical treatment. 
And the names and addresses of all such appli- 
cants shall be sent to the medical visitor of tl 
place in which they reside. 

8. In every case of cholera or diarrhcea, vth 
the patient is not under medical care and ti 
ment, the vestry or board shall cause medii 
assistance to be rendered with the utmost ex] 
dition, and such aid and comfort, nourishmei 
and accommodation, as the circumstances oft! 
case will admit, with the object of restor 
health. 

'.). The vestry or board shall provide c 
pctent nurses to aid every medical visitor in 
attendance upon the patients suffering from 
disease. 

1(1. When the medical officer of health 
commends, the vestry or hoard shall, with 
much despatch as practicable, provide fit and 
proper accommodation for the reception of such 
patients as have no home, or cannot properly he 
treated at home, and may with advantage 
themselves be removed, -and shall cause the sai 

i be provided with all appliances, medicim 



I 



I 



HOW TO PREVENT CHOLERA. 75 

furniture, and other things necessary for the 
emergency, aud shall Appoint a legally qualified 
medical practitioner, with or without assistant, 
as the case may require, to attend to the same. 

11. If cholera or choleraic diarrhoea exist in 
any Swelling whereof the medical officer of 
health reports that the sick and healthy cannot 
therein he properly separated, the vestry or 
hoard shall forthwith cause adequate accommo- 
dation to he procured for the reception of tho 
healthy; and, when the medical officer of health 
recommends that the sick person shall not he 
removed, hat that the healthy shall he removed 
from the same room in which the sick person is 
lying, the vestry or hoard shall cause tho other 
inmates of such room to he removed to some 
convenient place of reception. 

12. Tho vestry or hoard shall, in dwellings 
where cholera or diarrhoea exists, cause proper 
disinfectants tu bo used in sufficient quantities 
for the purposo of disinfecting the discharges 
from tho sick, and tho bedding, clothing, and 
other things thereby infirted, and the utensils 
and privies in which such discharges may have 
been received. 

13. The vestry or board shall cause every 
article of elothiug, bedding, or furniture which 
shall have been infected vsitii rav-j sm^u K\%fiftas^ 



70 HOW TO TEEVENT CHOLERA. 

and which they shall find incapable of bei: 
speedily disinfected, to be forthwith destroyi 
the vestry or board within a reasonable time 
placing all such articles, or paying the reasi 
able value to the owner. 

U. If it be shown to the vestry or boarct tl 
any drinking-water used in their parish or di: 
trict is polluted, they shall take measures, wM 
as much expedition as possible, for procurinj 
wholesome water to be supplied in its stead, so 
far as the case requires, to the inmates of the 
houses in their parish or district, and for pre- 
venting, as far as possible, the further use of the 
polluted water. And every vestry or board 
owning or having possession of any waterworks 
for the supply of water shall cause the reservoirs, 
cisterns, pipes, pumps, and other apparatus he 
longing thereto, to be carefully examinei 
cleansed and purified, and other necessary mei 
Bures to be taken, so that tlio water may 
supplied without impurity. 

15. The vestry or board shall make due 
rangements with undertakers, and with thi 
proper authorities of the churchyards, 
grounds, and cemeteries of their parish or di: 
trict, so that coffins may bo ready to be supplied 
immediately on demand, and interments speedily 
take place in the cases of deaths arising from 



: 



HOW TO PREVENT cholera. 77 

cholera or diarrhoea ; and the ve9try or board 
shall, when informed of any such death, cause 
the corpse to be buried with the earliest possible 
despatch. 

16. Where any death shall occur from cholera 
or choleraic diarrhoea, no collection of persons 
shall assemble in the room where the corpse is, 
and no " waking" of the dead shall be allowed. 

17. The vestry or board shall cause the im- 
mediate removal, from any room which living 
persons inhabit, of the corpse of every person 
dying, from cholera or choleraic diarrhoea, until 
the time of its interment, and shall cause such 
means to be adopted % for preventing the spread 
of infection from the corpse as their medical 
officer of health shall recommend. 

18. If the vestry or board shall be informed 
that cholera or choleraic diarrhoea exists, or 
within three days previously has existed, in any 
ship or vessel which may be lying within their 
parish or district, they shall cause the same to 
be forthwith visited, inspected, and otherwise 
dealt with, according to the circumstances of the 
case, in like manner as if it were an inhabited 
house on shore, and shall give all such medical 
and other directions in reference to the persons 
in such vessel or ship, as shall be requisite for 
preventing the spread of the disease, and for the 



78 HOW TO PREVENT CHOLERA. 

disinfection or disposal of any things which may 
be infected or may have been exposed to infec- 
tion, subject always to the provisions of any 
Order of Council issued under the Quarantine 
Laws for the time being in force in such parish 
or district. 

These directions embrace almost all that is 
possible to be done by a community anticipating 
an invasion of cholera. 



CHAPTER VIII. 



WHAT TO DO WHEN CHOLERA BREAKS OCT. 



Supposing all precautions to fail, and a case or 
cases of cholera occur in a house — what is to be 
done ? Now, we need not say that a medical 
man should he sent for at once, and that to him 
should be entrusted the management of all 
matters relating to the sick person and the pre- 
servation of the family from its further spread. 
But, as in all cases much precious time may he 
lost in waiting for the medical man, and persons 
may he placed in situations where a medical 
man cannot he had, we shall here say a few words 
with regard to action where cholera breaks out. 

In the first place, then, we would say that when 
cholera is about, every case of ordiuary diarrhoea, 
or looseness of the bowels, should be treated as 
a case of cholera. All cholera is attended with 
a premonitory diorrhcea, which in that stage is 
not distinguishable from an ordinary purging. 
Whenever, therefore, purging commenc 
individual he should regard himself as sick, 



80 WHAT TO DO 

such persons should, if possible, forego their usual 
occupations, and keep in hed. They should be 
covered up warm, and some medicine containing 
a small quantity of Opium should be given them 
at ouce. This dose should be repeated after 
every liquid evacuation. It would be well for 
persons to keep in the house a diarrhoea mix- 
ture. The following is a good one : — 

Laudanum 5 drops. 

Compound Tincture of Catechu . 30 drops. 

Cajuput Oil 1 drop. 

Chalk Mixture Jan ounce. 

If the mixture cannot be easily obtained, five 
drops of laudanum in half a wineglassful of pep- 
permint water or weak brandy- and- water should 
be substituted. 

It is unnecessary to multiply prescriptions for 
popular use ; but should any one possess any of 
the preparations of opium of the British phar- 
macopoeia, they should remember that about the 
third of a grain of opium may be given after 
every liquid evacuation. The dose should be less 
for children. Half the dose for an adult should 
bo given to children under ten years of age, and 
from a drop to two drops of laudanum for children 
under five years of age. It should, however, be 
recollected that domestic treatment is always 



aye 



WHEN CHOLERA I1REAKS OUT. 

hazardous, and nothing can substitute the eyi 
of the experienced medical practitioner. 

With regard to diet, it should consist inainb 
of slops ; of beef-tea, broth, gruel, or rl 
Caution should be used with regard to t" 
administration of stimulants. Whilst 
brand y-and- water may he of great ; 
saccharine wines and beers, by produeii 
acidity on the stomach, may do great harm. 
When good brandy cannot he obtained, the best 
substitute is Scotch or Irish whisky. 

If, unfortunately, no medical aid should be at 
hand and the stools become colourless and watery, 
assuming the character known by the 
"rice-water," and vomiting should increase, am 
coldness and hlueness come on, the opium shouli 
be discontinued and ardent spirits avoided. 
The patient should be allowed to drink col 
water freely, and should he abundantly su; 
plied with fresh air. He should lie in bed and 
warm applications he made to the feet and legs, 
nnd a mustard poultice or a pledget of linen 
dipped in turpentine should be applied to the 
stomach. The ports affected with cramps should 
he rubbed with the warm hand. It is efficient 
nursing, and not medicine, that does most good 
in this stage. 

Thus much with regard to fee VtefltaassA 



i 

•A. 

: 

nd 

be 
Id 
nt 



82 WHAT TO HO WHEN CHOLERA BBEAKS ODT. 

the patient, we now come to the question of 
what is to be done outside the patient, and one 
of the first things to be attended to here is the 
prevention of the spread of the cholera poison. 
Everything that the patient has worn, his night- 
dress and the sheets on which he lies, nnd the 
bedding and bed- furniture should be looked 
upon as capable of spreading the disease, and 
Bhould he disinfected or destroyed. The safer 
way is, undoubtedly, to destroy by fire all soiled 
linen and clothes. Other things should be im- 
mediately disinfected and then plunged in boil- 
ing water. All that passes from the sick should 
be looked upon as highly poisonous, and should 
first be disinfected and then got rid of at once. 
Every sink, and vessel, and cloth, or article of 
bedding or clothing that have touched either the 
vomit or the stools should he disinfected. The 
closets or drains into which they are thrown 
should he constantly treated with some form or 
other of the various commonly used disinfectants. 
Those who die of cholera should as speedily as 
possible be placed in their coffins and buried. 
At the bottom of the coffin should be placed a 
layer three or four inches deep of charcoal. 
The body should he sprinkled with a solution of 
some permanganate-, and a layer, of charcoal 
should be put on the top of the body and the lid 
screwed down immediately, , 



■ 



CHAPTER IX. 



ON DISINFECTANTS. 



Ol'R essay would be incomplete without a few 
words on the nature of those substances which 
have been so often recommended under the name 
of "Disinfectants." Deodoriser is another term 
applied to the same set of substances. They 
are undoubtedly useful auxiliaries. When con- 
tagious diseases however break out, it should 
always he recollected that they are no substi- 
tutes for cleanliness and ventilation. In fact, if 
no other precautions are employed, they may he 
worse than useless as leading to a confidence 
which the experience of their employment 
does not justify. It ia not always when bac 
smells are removed hy their agency that 1 
poison of disease has been destroyed. 

Disinfectants act in two ways; — first, by pre- 
venting the diffusion of poisons; and secondly, 
by destroying these poisons. Thus we find that 
extreme cold and extreme heat act unoa wamA 
poisons in these ways. "Extreme cAi. -^ws"*«o^ 



84 OX niSINFECTANTS. 



poisons from being diffused and oxidized, whilst 
extreme heat destroys the chemical structure 
the poison, nnd assists tho action of oxygen. 
It is in this way we may account for the arrest 
of contagious diseases by the existence of ex- 
tremes of atmospheric heat and cold. 

The agents which act in the same way as cold 
are carbolic acid, kreasote, camphor, must, al- 
cohol, and other chemical agents. Of these 
only one is generally available for disinfecting 
purposes during cholera, and that is carbolic 
acid. This acid can be obtained pure and 
added to water; one part of acid to fifty of 
water may he applied as a solution for washing 
out drains and sinks, and yards, and a stronger 
solution may be used for mixing with cholera 
evacuations, and rinsing out chamber- utensils 
and other vessels infected with the evacuations. 

Carbolic acid is also used in conjunction with 
lime and other agents, and may thus be used in 
a Bolid form. This acid forms the principal in 
McDougall's disinfecting powder, which is sold 
in sealed bottles with holes over the mouth, so 
as to admit the powder being dusted about in 
the same mauner as pepper from a pepper- 
castor. 

There is another acid having the same pro^ 
pertiea &s carbolic acid, o*He4 acrylic 



lilst 
eof 



- 



ON DISINFECTANTS. 



88 



This acid, combined with lime aad other agents, 
is sold under the name of Calvert's Carbolic 
Acid Powder, in tin cases with holes at the top. 
This powder is sold wholesale nt 15s. per cwt,, 
or Gl. a ton. 

These powders may he used advantageously 
for disinfecting large spaces, such as drains and 
sewers, where men are working at removing the 
soil from cesspools and drains, coach-houses, 
stables, &c. 

Those agents which act by destroying animal 
and vegetable poisons are extreme heat, 
chlorine, ozone, permanganates of potash or 
soda, nitrous acid, sulphurous acid, iodine, bro- 
mine. Of these, the most available are heat, 
chlorine and ozone. It has been shown by ex- 
periment that a temperature equal to that of 
boiling water will destroy the poison of certain 
infectious diseases. As boiling water is easily 
procured in most households, a sufficient quan- 
tity should he ready, in which to plunge 
garments and linen which have been soiled by 
the person sick of cholera. This can be done 
after they have been removed from the 
the patient, when they have been heated with 
some other disinfectant. 

Chlorine is perhaps the most active oC 
disinfectants. The best^&N, to Hg^Tk^ 



n- 
tU 

by 
ne 

I 



86 ON DISINFECTANTS. 

infecting the air, is to use it aa gas. The v 
ready way of manufacturing it is to take 

Common salt, 4 parts, 
Peroxide of manganese, 1 part, 
Sulphuric acid (oil of vitriol) and water, 
of each 2 parts. 

Mix the salt and peroxide, and put them ini 
a basin, and then put in the oil of vitriol, and 
afterwards the water. This may be placed in 
some convenient part of the room to he disin- 
fected, caro being taken not to mix too large a 
quantity for the room, and to avoid directly 
breathing the purs chloride. 

When persons have not sufficient confidence 
in their chemistry to use the above, " chloride of 
lime," as it is called, may he employed, whicl 
when placed in water slowly evolves chlorii 
and is a very manageable substance. 

Ozone is an active form of oxygen gas. 
Oxygen i3 nature's great disinfectant. The 
world is kept from putridity and death by oxygon. 
At the same time ozune is not easily manufac- 
tured pure for disinfecting purposes, but in per- 
manganic acid we have a large quantity of 
ozone, which is readily given off when it comes 
in contact with organic matters. This acid 
forms permanganates which are e&aiVj mwiuW- 
tured, and a solution of them is now w>W is 



lOf 

ch, 

... 

fas. 



ON DISINFECTANTS. 87 

the shops under tlie name of Condy's disinfect- 
ing fluid. The permanganates speedily give out 
their ozone and become a ready means of disin- 
fection. Condy's fluid is well adapted for dis 
infecting liquids of all kinds, also for floors, 
furniture, and clothes; but tho ozone is not 
given off from this preparation into the 
Hence it is useless to employ it for diffusii 
ozone. 

We have before alluded to water containing 
oxygen, and it is in this way that water itself 
may become a disinfectant. It can, however, only 
he where water is free from organic matter that 
it acts thus. It is where water is charged with 
organic matter that it conveys the poison 
cholera; and, unfortunately, this is often tl 
case with our rivers and wells. 

There are many other disinfectants or deodo- 
risers, but those we have mentioned above are 
tbo best known and most readily accessible. 
The following demand, however, attention, and 
may he used when found convenient, * 

Chloride of zinc is the basis of "Burnett's 
Fluid." It has the power of destroying amino- 
niacal compounds and organic matter, and thus 
acts as a disinfectant. 

Perchloride of iron has the power of destro^- 



t 

Lis- 
ts, 
aot 

:ng 

ing 
self 
ily 
nit 

ith 

s 




"Iff 8 



ON DISINFECTANTS. 



ig sulphuretted hydrogen, and thus of deo< 
rising the decoying compounds to which it 
added. 

Iodine is an expensive deodorising agent, 
is said to be very efficacious. It decompost 
sulphuretted hydrogen and arrests putrefucti 
It is best used by exposing pure iodine in 
room upon a hot plate. 

Nitrons acid is a powerful deodoriser and dis- 
infectant. It can easily be produced by putting 
a piece of copper into nitric acid, when red fumes 
are produced which are nitrous acid. 

Sulphurous acid, which is evolved win 
sulphur is burned in the open air, has bi 
strongly recommended as a disinfectant, but 
fumes are very stifling and oppressive. 



We have now finished the task 
selves on commencing this little work. Oi 
object has been to indicate the nature of the 
terrible disease which has now for the fourth 
time visited our country. We feel convinced 
that when once the causes and means of pi 
venting this disease are fully understood 
the great bulk of the community it will bo di: 
armed of its terrors and deprived of its power 
destroying life. It is one of those visitations 
Providence that result from the ignorant brcaki 



img 

mes 

: 

the 
rtl! 
:ed 

! 



ri ON DISINFECTANTS. 81* 

of those laws by which the lives of human beings 
are governed. At this moment we have to deal 
with its awful presence, but we may hope by in- 
telligent fiction, and Christian courage, that its 
stay amongst ns may be of brief duration. 
Our future freedom from its dreaded visitations 
must be looked for in the improved health and 
intelligence of our poorer classes. This object 
can only be obtained by the educntion of the 
great mass of the people. We need in our 
universities, our high schools and middle- 
class schools, our Sunday-schools and ragged 
schools, a larger teaching of those laws of life 
on which the health of the people depends. 
"My people perish, and there is none to con- 
sider," was the divine complaint of old, and 
surely it is most appropriate now ! We are 
surrounded by tbo sources of disease and death, 
" Surely the curse causeless will not come ;" 
and if we have in these remarks shown that our 
present affliction has arisen from causes over 
which man holds almost supreme control, 
we ought to have done enough to awaken in 
every intelligent mind a sense of the duty of 
earnestly studying the nature of those causes 
the removal of which the Almighty Disposer 
of events has so evidently placed within out 
reach. 



APPENDIX 



REMARKS ON THE "BLUE MIST" OBSERV 
BY MR. GLAiSUER. 

By E. Ray LankesteRj Esq., of Christcluich, 
Oxford. 

It was suggested by Mr. Glnislier that it would 
be desirable to make an examination of the I 
mist noticed by him, by means of the mioroscope, 
and accordingly the following means were used 
for obtaining any particles which might ho pre- 
sent in the air in order to examine them 
Slips of glass were cleaned and exposed under 
trees where the blue mist was observable. Sit 
A pane of window-glass was cleaned and t 
posed to the mist for ten days, at Hampstead ; 
the translucent film which had collected on it 
was removed with pure boiled -water and a clean 
brush. 3rd. A pair of bellows, carefully cleaned, 
was made to blow the " mist" for half an hour 



rough n small bottle of perfectly pure water, 
The sediment from the water and the slips of 
glass were at once examined ; besides a few 
iusect'Scales and dust grains — in all, three cases 
— a great abundance of minute granular aggre- 
gations was seen, the largest of the granules 
exceeding l-6000th of an inch in diamt 
The granules were highly refractive, and pr< 
sented all the characters of fungoid growths, 
being similar to the spores of the yeast plant 
and other moulds. The abundance of these 
spherical granules, sometimes grouped iu chain! 
was very noticeable. 

In a paper read by Mr. Jabez Hogg to tin 
Microscopical Society of London, I find thai 
during the cholera visitation of 1854, the Rev. 
Lord Godolphin Osborne obtained these fung 
spores from the neighbourhood of cesspools, 
gullylioles, &.c, and termed them " atrozoa.' 
Mr. Hogg has himself observed them ever 
that time in all places and at all seasons 
remarks that there is no doubt that at the em 
of hot weather, and in the autumn time, tin 
are most abundant. 

There is no evidence whatever that the fungus 
spores noticed in the blue mist are peculiar in 
their nature, or connected in any wa^ vriilt 

lolera. The only tVvmg -c(;'hvmS&s^ 



rre- 
not 
■ter. 
ore- 
ths. 



iq-*. 



92 APPENDIX. 

them is their very great abundance, which though 
by no means so great as to lead to the belief that 
they actually compose the mist, may perhaps 
account for its density and greyish or light-blue 
colour. 

It may be mentioned that "blights" or dense 
mists, carrying innumerable fungus spores, are 
not uncommon local occurrences, resulting in 
the disease and destruction of many crops. 



B. 

The following directions for the use of dis- 
infectants, and printed on gummed paper, for 
attaching to bottles, &c, have been drawn up 
by Mr. Johnstone, of the Saint James's Dis- 
pensary : — 

POISON. 

CHLORIDE OF LIHE. 

Four or Five handfuls to be thrown down any 
place that smells badly. 



APPENDIX. 93 

POISON. 

CHLORIDE OE SODA. 

Half-a-pint to be added to each gallon of 
hot or cold water used in washing blankets, 
sheets or clothes of persons ill with Diarrhoea 
or Cholera. 

POISON. 

CARBOLIC ACID. 

Half-a-pint to be added to each pail of hot 
or cold water used in scrubbing floors of houses 
where there is Diarrhoea or Cholera. 



POISON. 

CONDY'S DISINFECTING FLTTID, 

About a Table-spoonful to be added to each 
quart of water used for washing basins, bed- 
pans, &c, or the hands of persons nursing 
people ill with Diarrhoea or Cholera. 



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